Every day at 4pm, a nurse enters Pop’s room and, after exchanging pleasantries, hands him a little paper cup with three pills in it. He takes one out, puts it in his mouth, reaches for the ever-present glass of water on the table next to him, draws some water through the straw and swallows the pill. He repeats this until all the pills are gone.
Today, the nurse came in, exchanged pleasantries, and gave Pop his little cup. He held that cup at chest level for many long moments without initiating the long-familiar process. The nurse and I chose just to watch. After a while, Mom got up from her chair, picked up the glass of water and told Pop to take a pill from the cup. He contemplated the cup and then attempted to take all the pills in one swallow. Mom stopped him, and talked him through the process, step by step. She was steady and patient; almost professional.
Also today, I presented Mom & Pop with their quarterly financial report; two pages: 1) a text narrative, and 2) a color graph. Usually, he dives into it and she defers the reading to later. Most of the time, neither will have any questions. This time, Mom deferred as usual. Pop took his copy, gazed at it oddly, put it down, picked it up, looked at the graphic only, and put it down again. He did this several times more without a word.
We got talking about Pop’s walking-for-exercise efforts which are much diminished. Mom wondered if a cane with three or four “feet” on it would help. I wondered if a walker would help. Mom was the last to use theirs, so I made adjustments to it and took Pop into the hallway for a test walk. After more adjustment, he seemed to think well of the thing, and said he’d give it a whirl tomorrow (my words, not his).
The walking came up because Pop’s beginning to miss important medical appointments. Last week it was his ophthalmologist. This week it’ll be his urologist. I’ll have to reschedule both because morning appointments now do not seem doable. Pop wakes to his alarm, kills it, finds himself “dizzy”, turns over and goes back to sleep. He’ll finally arise at about lunchtime when the staff enters his room with food. (That’s his narration. Actually, medical staff enter the room several times each morning for a variety of good reasons.)
None of this is good news, I know. So I’ll take a few moments to share some results from recent tests initiated by Piedmont Place’s Nurse Practitioner, the person closest to his case. She reports today that Pop’s “…White Blood Cell count has come down and his electrolytes (except his calcium) and kidney function are within normal limits for him, indicating that he did drink enough over the weekend and that he is responding well to antibiotics. The diarrhea is better, 1-2 times a day with no fever.”
She also notes that Pop has considerable trouble answering questions directly and that he struggles to find words or to finish thoughts. So, she says, “he’s not out of the woods, yet.”
But the bad news is that “…his Calcium is trending upward, which can happen in an acute illness with volume loss, and if it goes any higher when I recheck on Friday, he may need an IV to bring this back down, which would mean a hospital admission because his hall doesn’t do IV’s since it is Assisted Living. Also, his amylase and lipase were elevated today. This could be due to his acute illness, but also could point more towards a problem with his pancreas (inflammation/infection). I have ordered an abdominal ultrasound in the morning (Tuesday) to review this, which should be enough to rule out a problem, without needing a CT scan.”
647 words to say that Pop ain’t doin’ so good today.